Is the Health and Safety Authority about to change its role monitoring the health sector? Catherine Reilly reports
The Health and Safety Authority (HSA) is establishing a new advisory committee for the health and social care sector. The committee will “place particular focus” on occupational health and safety in health and social care “in the same way as the construction and agricultural sectors”, according to the Department of Enterprise, Trade and Employment (DETE).
“The committee could also develop new and targeted activities aimed at reducing the large number of incidents, injuries, and accidents in the sector,” a DETE spokesperson told the Medical Independent (MI).
As of late October, the HSA’s board was considering the terms of reference and membership of the new committee.
The HSA is the State authority responsible for the administration and enforcement of workplace safety, health and welfare law. It monitors compliance with legislation and can take enforcement action (up to and including prosecutions, although these cases have rarely been taken against healthcare employers).
The Authority was accorded €3.1 million in additional funding in Budget 2024. The DETE spokesperson said this provision will support HSA recruitment and delivery of targeted guidance, advisory, and promotional initiatives in “priority sectors”. It was not stated what proportion of the new funding would be assigned to activity in the health sector.
According to the DETE spokesperson, additional funding for the HSA had led to an “increased focus” in healthcare in recent years. The Authority now has a “a dedicated national policy and inspection team” focusing on the sector as part of the newly established Occupational Health Division.
“The HSA is prioritising the health sector and is carrying out a mix of proactive and reactive inspections across the sector as well as providing health sector-specific information and guidance and e-learning programmes on managing occupational health and safety in healthcare settings,” stated the DETE.
Last year, the HSA carried out 510 inspections and investigations in the health and social care sector (compared with 446 in 2021), resulting in 342 written advices, 12 improvement notices, and one prohibition notice.
To date in 2023, it has conducted inspections in 26 emergency departments. “Inspections cover a range of occupational health and safety issues, and enforcement action is taken if required,” according to an Authority spokesperson. By press time, no further information was provided on the nature and outcome of these inspections.
On 30 June, the Irish Nurses and Midwives Organisation (INMO) advised members of the planned establishment of the new HSA advisory committee following a lobbying campaign. It described the development as a “huge turning point” for the safety and wellbeing of nurses, midwives, and other healthcare workers.
It said the aim of the committee would be to reduce injury and ill-health and improve compliance with occupational health and safety within the sector. Advisory committees for farming and construction had been “transformative” in respect of reducing injuries and fatal accidents in these sectors, outlined the INMO.
To date, the level of HSA activity and impact in healthcare has been a source of concern among healthcare unions.
Last February, INMO General Secretary Ms Phil Ní Sheaghdha told the Oireachtas health committee that HSA officials had informed the union it required additional funding for a “separate division to deal with the health service”. She said the HSA was “failing in its regulatory function” in respect of the health sector, while the employer was failing in its duty of care to staff.
This meeting heard an array of concerns about the welfare of staff in public healthcare services. These included high prevalence of mental ill-health and burnout, frequent abuse and assaults of staff, exposure to Covid-19 and lack of long Covid supports, and workplace bullying. Understaffing and lack of capacity were contributing to many of these issues, the meeting heard.
Healthcare staff also indicated an under-reporting of abuse and assault incidents due to several factors including service pressures, lack of confidence in existing procedures, and a cultural reluctance to report.
Dr Clive Kilgallen, the then IMO President, commented at the meeting: “When I talk to some of my colleagues in the coffee room, people do not feel comfortable talking about it. When they say, ‘something bad happened to me’, I will ask have they logged it in and they will say, ‘no, I cannot do that’.”
As well as addressing understaffing and capacity issues, Dr Kilgallen advised of the need for “clear policies and procedures” to ensure all healthcare professionals felt able to take time-off when ill. They should have access to an “appropriately resourced” and fully consultant-led occupational health service, he outlined.
This newspaper contacted the IMO for a comment on the HSA’s planned advisory committee and awaited a response at press time.
Mr Kevin Figgis, Divisional Organiser, Siptu Health, commented that it would welcome a mechanism in the HSA that focused on concerns in the health service. “The key is going to be in the detail, though, because the health service is vast…. It would want to be fairly robust to meet with the challenges that I think would naturally arise once they started about their work.”
He also drew attention to the negative impact of understaffing on staff, patients, and delivery of services, and criticised the “arbitrary” decision to impose a recruitment freeze on a number of grades (including NCHDs, healthcare assistants, and home help staff), with “no consultation”.
Ms Ní Sheaghdha of the INMO told MI it has lobbied the HSA to enhance its activity in healthcare for a number of years.
“We met with the previous CEO and set out our submission. We were disappointed that the Health and Safety Authority of itself… didn’t see that the health sector, as an employment location, required special attention despite the numbers of assaults increasing considerably.
“We have examined their annual report for the last three years and noticed that the areas where they have advisory committees in place had a lot more inspections, a lot more follow-on, and had a lot more prosecutions. So, we then went to the Minister with responsibility [for the HSA], Simon Coveney, and we presented this as part of our submission.”
Ms Ní Sheaghdha said there is evidence of premature retirements among nurses and midwives arising from the ill-effects of their working conditions. A precautionary approach is not in place to mitigate potential occupational health issues, despite well-established risk factors, she outlined.
“If you look at junior doctors and the hours they work, that is going to lead to problems. If you look at the shift patterns, if you look at somebody’s exposure, for example, to night duty… the research is all there in respect of the circadian rhythm and what it does to your long-term life expectancy. We are saying these matters have to be factored in when you are an employer and the HSE and health service… in our view they do not provide sufficient safety or provision under Section 8 of the Health and Safety Act,” which requires employers to ensure the health and safety of their employees.
Ms Ní Sheaghdha said the INMO was not aware of any recent increased activity by the HSA in healthcare. Furthermore, it is urging the HSA to widen its monitoring approach and examine the indices of staff burnout in the sector. She noted that ‘personal injury’ encompasses both physical and mental health conditions under health and safety legislation.
According to Ms Ní Sheaghdha, the HSA should be examining whether the workplace is contributing to a prevalence of health conditions among staff.
“So when they go into an area where, and this is just an example, you have had higher than normal instances of sick leave, or you have had a number of accidents post-leaving work, you have to look behind that and look at what is causing it. Are people working beyond the normal end time of their shift? Is it because the staffing levels are such that they are actually doing the work that should be covered by three people because patient volume has increased, but also their staff numbers have decreased?”
She said the HSE recruitment freeze on a number of healthcare grades (although not nurses/midwives) will increase pressure on staff. The Government must understand there is a global market for healthcare professionals, who are mobile, underlined Ms Ní Sheaghdha
“Scoring own goals by putting in recruitment embargos makes no sense, but furthermore, it indicates very clearly to nurses and midwives, and to us in representing them, that there still isn’t an understanding that healthcare is delivered by humans. There is no alternative. The more you cut the staff, the less the service you are going to have. And even more worryingly, the more unsafe your service is going to become.”